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Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance.

ABSTRACT: Although necessary for developing a rationale for vaccination, the burden of severe respiratory syncytial virus (RSV) disease in children in resource-poor settings remains poorly defined.We conducted prospective surveillance of severe and very severe pneumonia in children aged <5 years admitted from 2002 through 2007 to Kilifi district hospital in coastal Kenya. Nasal specimens were screened for RSV antigen by immunofluorescence. Incidence rates were estimated for the well-defined population.Of 25,149 hospital admissions, 7359 patients (29%) had severe or very severe pneumonia, of whom 6026 (82%) were enrolled. RSV prevalence was 15% (20% among infants) and 27% during epidemics (32% among infants). The proportion of case patients aged 3 months was 65%, and the proportion aged 6 months was 43%. Average annual hospitalization rates were 293 hospitalizations per 100,000 children aged <5 years (95% confidence interval, 271-371 hospitalizations per 100,000 children aged <5 years) and 1107 hospitalizations per 100,000 infants (95% confidence interval, 1012-1211 hospitalizations per 100,000 infants). Hospital admission rates were double in the region close to the hospital. Few patients with RSV infection had life-threatening clinical features or concurrent serious illnesses, and the associated mortality was 2.2%.In this low-income setting, rates of hospital admission with RSV-associated pneumonia are substantial; they are comparable to estimates from the United States but considerably underestimate the burden in the full community. An effective vaccine for children aged >2 months (outside the age group of poor responders) could prevent a large portion of RSV disease. Severity data suggest that the justification for RSV vaccination will be based on the prevention of morbidity, not mortality.

SUBMITTER: Nokes DJ

PROVIDER: S-EPMC2762474 | biostudies-literature | 2009 Nov

REPOSITORIES: biostudies-literature

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Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance.

Nokes D James DJ Ngama Mwanajuma M Bett Anne A Abwao John J Munywoki Patrick P English Mike M Scott J Anthony G JA Cane Patricia A PA Medley Graham F GF

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20091101 9

<h4>Background</h4>Although necessary for developing a rationale for vaccination, the burden of severe respiratory syncytial virus (RSV) disease in children in resource-poor settings remains poorly defined.<h4>Methods</h4>We conducted prospective surveillance of severe and very severe pneumonia in children aged <5 years admitted from 2002 through 2007 to Kilifi district hospital in coastal Kenya. Nasal specimens were screened for RSV antigen by immunofluorescence. Incidence rates were estimated ...[more]

PMID: 19788358

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Project description:Abstract Background Respiratory syncytial virus (RSV) is a substantial source of severe illnesses including acute lower respiratory infections (ALRIs) like pneumonia. However, its burden in older children remains less well understood. Methods Using a community-based prospective cohort, we assessed the burden of symptomatic reverse-transcription polymerase chain reaction–confirmed RSV among Nicaraguan children aged 0–14 years from 2011 to 2016. ALRI was defined as physician diagnosis of pneumonia, bronchiolitis, bronchitis, or bronchial hyperreactivity. Results Between 2011 and 2016, 2575 children participated in the cohort. Of these, 630 (24.5%) had at least 1 episode of symptomatic RSV and 194 (7.5%) had multiple episodes. Subtype was identified in 571 (69.3%) episodes with 408 (71.5%) RSV-A, 157 (27.5%) RSV-B, and 6 (1%) positive for both. Children aged <2 years displayed the highest incidence of symptomatic RSV, with 269.3 cases per 1000 person-years (95% confidence interval [CI], 242.1–299.5). Beyond 2 years, incidence (95% CI) of symptomatic RSV decreased rapidly: 145.6 (129.9–163.1), 37.9 (31.9–45.0), and 19.3 (14.9–25.0) cases per 1000 person-years among children aged 2–4, 5–9, and 10–14 years, respectively. Incidence of RSV-associated ALRI was highest in children aged <2 years (85.95 per 1000 person-years [95% CI, 71.30–103.61]): 2.1, 9.5, and 17.3 times that of participants aged 2–4, 5–9, and 10–14 years, respectively. Children <2 years old were significantly more likely to have an RSV-associated hospitalization (P < .001). Conclusions There is a substantial burden of symptomatic and severe RSV in children. While older children did present with RSV, the rates of symptomatic and severe RSV decreased by as much as 95% beyond age 5. Respiratory syncytial virus (RSV) is a significant source of morbidity among children, though incidence rates decrease by as much as 95% by age 5. While affecting older children, RSV's strong association with age suggests interventions will be most impactful if targeting young children.

Dataset Information

Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance.

Publications

Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance.

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